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Article
Multisite parent-centered risk assessment to reduce pediatric oral chemotherapy errors
Meyers Primary Care Institute Publications and Presentations
  • Kathleen E. Walsh, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
  • Douglas W. Roblin, Kaiser Permanente
  • Colleen Biggins, University of Massachusetts Medical School
  • Joann L. Wagner, University of Massachusetts Medical School
  • Kathleen E. Houlahan, Dana-Farber Cancer Institute
  • Justin W. Li, Dana-Farber Cancer Institute
  • Christopher P. Keuker, University of Massachusetts Medical School
  • Karen Wasilewski-Masker, Emory Medical School
  • Jennifer L. Donovan, University of Massachusetts Medical School
  • Abir O. Kanaan, University of Massachusetts Medical School
  • Saul N. Weingart, Dana-Farber Cancer Institute
UMMS Affiliation
Department of Pediatrics; Meyers Primary Care Institute; Department of Medicine
Date
1-1-2013
Document Type
Article
Medical Subject Headings
Medication Errors; Antineoplastic Agents; Home Nursing; Child; Parents; Risk Assessment
Abstract
PURPOSE: Observational studies describe high rates of errors in home oral chemotherapy use in children. In hospitals, proactive risk assessment methods help front-line health care workers develop error prevention strategies. Our objective was to engage parents of children with cancer in a multisite study using proactive risk assessment methods to identify how errors occur at home and propose risk reduction strategies. METHODS: We recruited parents from three outpatient pediatric oncology clinics in the northeast and southeast United States to participate in failure mode and effects analyses (FMEA). An FMEA is a systematic team-based proactive risk assessment approach in understanding ways a process can fail and develop prevention strategies. Steps included diagram the process, brainstorm and prioritize failure modes (places where things go wrong), and propose risk reduction strategies. We focused on home oral chemotherapy administration after a change in dose because prior studies identified this area as high risk. RESULTS: Parent teams consisted of four parents at two of the sites and 10 at the third. Parents developed a 13-step process map, with two to 19 failure modes per step. The highest priority failure modes included miscommunication when receiving instructions from the clinician (caused by conflicting instructions or parent lapses) and unsafe chemotherapy handling at home. Recommended risk assessment strategies included novel uses of technology to improve parent access to information, clinicians, and other parents while at home. CONCLUSION: Parents of pediatric oncology patients readily participated in a proactive risk assessment method, identifying processes that pose a risk for medication errors involving home oral chemotherapy.
Comments

Citation: J Oncol Pract. 2013 Jan;9(1):e1-7. doi: 10.1200/JOP.2012.000601. Link to article on publisher's site

Related Resources
Link to Article in PubMed
PubMed ID
23633976
Citation Information
Kathleen E. Walsh, Kathleen M. Mazor, Douglas W. Roblin, Colleen Biggins, et al.. "Multisite parent-centered risk assessment to reduce pediatric oral chemotherapy errors" Vol. 9 Iss. 1 (2013) ISSN: 1554-7477 (Linking)
Available at: http://works.bepress.com/abir_kanaan/17/